Download PDF
Semin Plast Surg 2011; 25(1): 034-042
DOI: 10.1055/s-0031-1275169
© Thieme Medical Publishers

Stabilization of the Chest Wall: Autologous and Alloplastic Reconstructions

Raman Chaos Mahabir1 , Charles E. Butler2
  • 1Division of Plastic Surgery, Department of Surgery, Scott and White/Texas A&M University, Temple, Texas
  • 2Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas
Further Information

Publication History

Publication Date:
05 April 2011 (online)

Also available at
    Permissions and Reprints

ABSTRACT

The goals of chest wall stabilization include maintenance of a rigid airtight cavity, protection of the thoracic and abdominal contents, optimization of respiration, and, whenever possible, an aesthetic reconstruction. Evidence suggests that bony fixation results in reduced ventilator dependence, a shorter overall hospital stay, and improved upper extremity function. We prefer to accomplish this with autologous tissue alone (such as the pectoralis major, latissimus dorsi, or rectus abdominus muscle flaps) for small to moderate defects. En bloc resection of defects larger than 5 cm or containing four or more ribs will likely benefit from chest wall stabilization. For patients previously treated with radiation, even larger defects may be tolerated owing to fibrosis. For these larger defects, methyl methacrylate composite meshes are used and covered with vascularized tissue. Contaminated wounds are generally reconstructed with bioprosthetic mesh rather than synthetic mesh. Using these principles, the reconstructive plastic surgeon can devise a comprehensive and safe plan to repair tremendous defects of the chest wall.

KEYWORDS

Chest wall - reconstruction - stabilization - autologous - alloplastic

REFERENCES

  • 1 Parham D W. Thoracic resection for tumors growing from the bony chest wall.  Trans South Surg Assoc. 1899;  2 223-363
    PubMedSearch in Google Scholar
  • 2 Fell G E. Forced respiration.  JAMA. 1891;  16 325-330
    PubMedSearch in Google Scholar
  • 3 O'Dwyer J. Fifty cases of croup in private practice treated by intubation of the larynx with a description of the method and of the dangers incident thereto.  Med Rec. 1887;  32 557-561
    PubMedSearch in Google Scholar
  • 4 Kroll S S, Walsh G, Ryan B, King R C. Risks and benefits of using Marlex mesh in chest wall reconstruction.  Ann Plast Surg. 1993;  31 303-306
    CrossrefPubMedSearch in Google Scholar
  • 5 Netscher D T, Eladoumikdachi F, McHugh P M, Thornby J, Soltero E. Sternal wound debridement and muscle flap reconstruction: functional implications.  Ann Plast Surg. 2003;  51 115-122 discussion 123-125
    CrossrefPubMedSearch in Google Scholar
  • 6 Ringelman P R, Vander Kolk C A, Cameron D, Baumgartner W A, Manson P N. Long-term results of flap reconstruction in median sternotomy wound infections.  Plast Reconstr Surg. 1994;  93 1208-1214 discussion 1215-1216
    CrossrefPubMedSearch in Google Scholar
  • 7 Cicilioni Jr O J, Stieg III F H, Papanicolaou G. Sternal wound reconstruction with transverse plate fixation.  Plast Reconstr Surg. 2005;  115 1297-1303
    CrossrefPubMedSearch in Google Scholar
  • 8 Spear S L, Hess C L. A review of the biomechanical and functional changes in the shoulder following transfer of the latissimus dorsi muscles.  Plast Reconstr Surg. 2005;  115 2070-2073
    CrossrefPubMedSearch in Google Scholar
  • 9 Castelló J R, Centella T, Garro L et al.. Muscle flap reconstruction for the treatment of major sternal wound infections after cardiac surgery: a 10-year analysis.  Scand J Plast Reconstr Surg Hand Surg. 1999;  33 17-24
    CrossrefPubMedSearch in Google Scholar
  • 10 Meadows III J A, Staats B A, Pairolero P C, Rodarte J R, Arnold P G. Effect of resection of the sternum and manubrium in conjunction with muscle transposition on pulmonary function.  Mayo Clin Proc. 1985;  60 604-609
    CrossrefPubMedSearch in Google Scholar
  • 11 Song D H, Wu L C, Lohman R F, Gottlieb L J, Franczyk M. Vacuum assisted closure for the treatment of sternal wounds: the bridge between débridement and definitive closure.  Plast Reconstr Surg. 2003;  111 92-97
    CrossrefPubMedSearch in Google Scholar
  • 12 Pairolero P C, Arnold P G. Thoracic wall defects: surgical management of 205 consecutive patients.  Mayo Clin Proc. 1986;  61 557-563
    PubMedSearch in Google Scholar
  • 13 Wall M J, Huh J. Chest wall, mediastinum, trachea: Chest wall trauma. In: Cameron J L, ed. Current Surgical Therapy. Philadelphia, PA: Elsevier, Mosby; 2001: 663-664
    Search in Google Scholar
  • 14 Disa J J, Klein M H, Goldberg N H. Advantages of autologous fascia versus synthetic patch abdominal reconstruction in experimental animal defects.  Plast Reconstr Surg. 1996;  97 801-806
    CrossrefPubMedSearch in Google Scholar
  • 15 Disa J J, Goldberg N H, Carlton J M, Robertson B C, Slezak S. Restoring abdominal wall integrity in contaminated tissue-deficient wounds using autologous fascia grafts.  Plast Reconstr Surg. 1998;  101 979-986
    CrossrefPubMedSearch in Google Scholar
  • 16 Boyd A D, Shaw W W, McCarthy J G et al.. Immediate reconstruction of full-thickness chest wall defects.  Ann Thorac Surg. 1981;  32 337-346
    CrossrefPubMedSearch in Google Scholar
  • 17 McCormack P M. Use of prosthetic materials in chest-wall reconstruction. Assets and liabilities.  Surg Clin North Am. 1989;  69 965-976
    PubMedSearch in Google Scholar
  • 18 Arnold P G, Pairolero P C. Chest-wall reconstruction: an account of 500 consecutive patients.  Plast Reconstr Surg. 1996;  98 804-810
    CrossrefPubMedSearch in Google Scholar
  • 19 Morgan R F, Edgerton M T, Wanebo H J, Daniel T M, Spotnitz W D, Kron I L. Reconstruction of full thickness chest wall defects.  Ann Surg. 1988;  207 707-716
    CrossrefPubMedSearch in Google Scholar
  • 20 Bell M L. Proplast reconstruction of the lower sternum.  Plast Reconstr Surg. 1981;  68 795-797
    CrossrefPubMedSearch in Google Scholar
  • 21 Allen R G, Douglas M. Cosmetic improvement of thoracic wall defects using a rapid setting silastic mold: a special technique.  J Pediatr Surg. 1979;  14 745-749
    CrossrefPubMedSearch in Google Scholar
  • 22 Cobb W S, Harris J B, Lokey J S, McGill E S, Klove K L. Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases.  Am Surg. 2003;  69 784-787
    PubMedSearch in Google Scholar
  • 23 Wainwright D J. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns.  Burns. 1995;  21 243-248
    CrossrefPubMedSearch in Google Scholar
  • 24 Rosen M J. Biologic mesh for abdominal wall reconstruction: a critical appraisal.  Am Surg. 2010;  76 1-6
    PubMedSearch in Google Scholar
  • 25 Bellows C F, Alder A, Helton W S. Abdominal wall reconstruction using biological tissue grafts: present status and future opportunities.  Expert Rev Med Devices. 2006;  3 657-675
    CrossrefPubMedSearch in Google Scholar
  • 26 Dubin M G, Feldman M, Ibrahim H Z et al.. Allograft dermal implant (AlloDerm) in a previously irradiated field.  Laryngoscope. 2000;  110 934-937
    CrossrefPubMedSearch in Google Scholar
  • 27 Buinewicz B, Rosen B. Acellular cadaveric dermis (AlloDerm): a new alternative for abdominal hernia repair.  Ann Plast Surg. 2004;  52 188-194
    CrossrefPubMedSearch in Google Scholar
  • 28 Lattari V, Jones L M, Varcelotti J R, Latenser B A, Sherman H F, Barrette R R. The use of a permanent dermal allograft in full-thickness burns of the hand and foot: a report of three cases.  J Burn Care Rehabil. 1997;  18 147-155
    CrossrefPubMedSearch in Google Scholar
  • 29 Eppley B L. Experimental assessment of the revascularization of acellular human dermis for soft-tissue augmentation.  Plast Reconstr Surg. 2001;  107 757-762
    CrossrefPubMedSearch in Google Scholar
  • 30 Butler C E, Langstein H N, Kronowitz S J. Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications.  Plast Reconstr Surg. 2005;  116 1263-1275 discussion 1276-1277
    CrossrefPubMedSearch in Google Scholar
  • 31 Diaz Jr J J, Guy J, Berkes M B, Guillamondegui O, Miller R S. Acellular dermal allograft for ventral hernia repair in the compromised surgical field.  Am Surg. 2006;  72 1181-1187 discussion 1187-1188
    PubMedSearch in Google Scholar
  • 32 Kim H, Bruen K, Vargo D. Acellular dermal matrix in the management of high-risk abdominal wall defects.  Am J Surg. 2006;  192 705-709
    CrossrefPubMedSearch in Google Scholar
  • 33 Gobin A S, Butler C E, Mathur A B. Repair and regeneration of the abdominal wall musculofascial defect using silk fibroin-chitosan blend.  Tissue Eng. 2006;  12 3383-3394
    CrossrefPubMedSearch in Google Scholar
  • 34 Holton III L H, Chung T, Silverman R P et al.. Comparison of acellular dermal matrix and synthetic mesh for lateral chest wall reconstruction in a rabbit model.  Plast Reconstr Surg. 2007;  119 1238-1246
    CrossrefPubMedSearch in Google Scholar
  • 35 Livesey S A, Herndon D N, Hollyoak M A, Atkinson Y H, Nag A. Transplanted acellular allograft dermal matrix. Potential as a template for the reconstruction of viable dermis.  Transplantation. 1995;  60 1-9
    CrossrefPubMedSearch in Google Scholar
  • 36 Butler C E, Langstein H N, Kronowitz S J. Pelvic, abdominal, and chest wall reconstruction with AlloDerm in patients at increased risk for mesh-related complications.  Plast Reconstr Surg. 2005;  116 1263-1275 discussion 1276-1277
    CrossrefPubMedSearch in Google Scholar
  • 37 Song D H, Lohman R F, Renucci J D, Jeevanandam V, Raman J. Primary sternal plating in high-risk patients prevents mediastinitis.  Eur J Cardiothorac Surg. 2004;  26 367-372
    CrossrefPubMedSearch in Google Scholar
  • 38 Molina J E, Lew R S, Hyland K J. Postoperative sternal dehiscence in obese patients: incidence and prevention.  Ann Thorac Surg. 2004;  78 912-917 discussion 912-917
    CrossrefPubMedSearch in Google Scholar
  • 39 Losanoff J E, Jones J W, Richman B W. Primary closure of median sternotomy: techniques and principles.  Cardiovasc Surg. 2002;  10 102-110
    CrossrefPubMedSearch in Google Scholar
  • 40 Pai S, Gunja N J, Dupak E L et al.. In vitro comparison of wire and plate fixation for midline sternotomies.  Ann Thorac Surg. 2005;  80 962-968
    CrossrefPubMedSearch in Google Scholar
  • 41 Wu L C, Renucci J D, Song D H. Sternal nonunion: a review of current treatments and a new method of rigid fixation.  Ann Plast Surg. 2005;  54 55-58
    CrossrefPubMedSearch in Google Scholar
  • 42 Raman J, Straus D, Song D H. Rigid plate fixation of the sternum.  Ann Thorac Surg. 2007;  84 1056-1058
    CrossrefPubMedSearch in Google Scholar

Raman Chaos MahabirM.D. 

Associate Professor and Chief of Microsurgery, Division of Plastic Surgery, Department of Surgery, Scott and White/Texas A&M University

2401 South 31st Street, Temple, TX 76508

Email: rmahabir@swmail.sw.org